Creating a Culture of EMR Adoption

A new survey of CIOs from 15 leading hospitals and health systems nationwide is confirming what numerous industry experts have been warning for some time—that achieving meaningful use under the Health Information Technology for Economic and Clinical Health (HITECH) Act will likely prove far more difficult, expensive, and time-consuming than most healthcare IT leaders in provider organizations may be anticipating. Kristin Ficery, senior executive in the health practice at the New York-based Accenture, and her colleagues, have produced a report based on the survey of leading-organization CIOs.

Among other conclusions in the report:

“Most of the health systems in our benchmarking study underestimated (by nearly 100 percent) the time and costs associated with implementing advanced EMR functions, including clinical order entry, nursing and physician documentation, clinical decision support and bar-coding medication.”

“IT operating costs will spike, and managing them requires leadership alignment and patience. Benchmarking shows that hospitals experience an 80 percent increase in their IT operating expenses while transitioning to EMR.”

“The war for health IT talent is on. There is a significant shortage of qualified health IT professionals to meet the demand associated with EMR implementation and support.”

“Supporting EMR means thinking differently about capability and operating model needs… The average hospital had to increase the number of FTEs focused on healthcare IT support by 45 percent as it reached mature levels of functionality and adoption.”

Ficery spoke recently with HCIEditor-in-Chief Mark Hagland regarding the survey and the conclusions of the report that she and her colleagues based on the survey. Below are excerpts from that interview.

Healthcare Informatics: How many people were surveyed?

Kristin Ficery: We interviewed 15 CIOs of leading academic medical centers and community hospitals across the country; these were large, integrated systems—in terms of operations, they represented from $1 billion to $14 billion in annual revenues. They were marquee-name health systems. Our goal was to interview those organizations that are further along [in preparing to achieve meaningful use], so that they could provide lessons learned for those not quite as far along.

HCI: When were the interviews conducted?

Ficery: Between April and August 2010.

HCI: In your report, you and your colleagues determined that fewer than 1 percent of U.S. hospital-based organizations were “mature” when it came to EMR development. How did you define “mature”?

We used stage 7 in the HIMSS Analytics schematic for the definition of “mature.” And there’s a table in the document that showed 0.7 percent of hospitals being at stage 7 in 2009. That was the highest level of maturity, but we assumed there would be some gray, some leeway, so we grouped stages 4 through 7, and found 15 percent were within the meaningful-use strike zone.

HCI: That’s still not very good!

Ficery: Yes, that’s the premise of the article, as you still had 50 percent in the early stages. We surveyed the industry and found it has been taking five to seven years to take an average 500-bed hospital from stage 1 in the HIMSS Analytics schematic through to completion of the meaningful use requirements.

HCI: In other words, the meaningful use process, taken in its entirety, is far more complex than it appears, correct?

Ficery: Exactly. This isn’t a simple check-the-box process, nor is it just about the implementation of a system. This really hits the big three for hospitals: first, it directly impacts the way that physicians and other clinicians carry out their work; second, this is hitting the bottom line of hospitals’ balance sheets at a time when many hospitals are very fragile, with one-third of hospitals operating in the red, and the average operating margin at about 5 percent right now. And third, doing this involves putting a lot of stock into the IT organization. And traditionally in hospitals, the IT organization has not been treated as a strategic part of the organization. So now we’re having to put a lot of stock and faith in the ability of the IT department to drive something that greatly impacts every aspect of the organization.

HCI: What should CIOs and other healthcare IT leaders be thinking about as they pursue meaningful use?

Ficery: They have to shape this as a transformational program; the ones we talked to really did frame it that way, with the end in mind. And if you can shape it that way, you really can align the right people and resources to move in the right direction. That is one key, I think. The other thing that was clear from these interviews is how the CIOs who were successful had really engaged their colleagues in the c-suite, in terms of defining the vision, and then pursuing strategies; then the tactics follow.

HCI: Many CIOs may be pursuing this tactically rather than strategically, then, right?

Ficery: Perhaps; I want to be careful, but I think that’s probably fair, given where the IT organization has traditionally been.

HCI: Have there been any sequencing commonalities among the leader organizations?

Ficery: Let me answer that by referencing one of the leader organizations. At that organization, they took a very analytic approach to this, and asked, what do we need to be able to answer? What do we need to be able to report on? What kinds of things do we need to do in order to make our clinicians more effective? And from there, they decided on the sequencing and actions.

HCI: Will that vary by organization?

Ficery: I think so; and I think it probably varies in many ways, too, in terms of where your readiness is already. Some organizations had already done some upfront readiness assessments, and also, honestly, in terms of who raised their hands to get involved. And I suspect that vendors probably influenced sequencing as well. But I do think it’s very important to think about what the end goal is; these leaders had a vision and an end in mind, and that influenced the actions and the journey.

HCI: Do you have any specific predictions with regard to what might happen in the next two years?

Ficery: I think we’re going to see potentially some pushback to the requirements, as people realize it is tougher than they thought. I think we’re going to continue to see the scarcity of resources, which will compound the issue. I do believe we’ll see a lot of hospitals pushing back on whoever they can push back on, as they face penalties, to get some relief.

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